title: Levobupivacaine vs. bupivacaine for third molar surgery: quality of anaesthesia, postoperative analgesia and local vascular effects.
abstract: OBJECTIVE
  The main purpose of this prospective, double-blind, randomized study was to evaluate anaesthetic parameters, postoperative analgesia and vasoactive properties of levobupivacaine and bupivacaine for lower third molar surgery.
  
  
  METHODS
  Sixty patients (ASA I) were scheduled for lower third molar surgery under inferior alveolar nerve block, lingual nerve block and buccal nerve block (mandibular nerve blocks) obtained with 3 ml of 0.5 % levobupivacaine and 3 ml of 0.5 % bupivacaine. Success rate, onset and duration of three nerve bocks were evaluated by electrical pulp testing, pinprick testing and signs of soft tissue anaesthesia (patient-reported numbness). Intensity of intraoperative anaesthesia and postoperative analgesia were measured with visual analogue scale (VAS) and numeric rating scale (NRS). The time of first postoperative pain reported and analgesic consumption were also recorded. The laser Doppler flowmetry was used for the measurement of the first premolar pulpal blood flow.
  
  
  RESULTS
  There were no differences between levobupivacaine and bupivacaine regarding the success rate, onset and duration of mandibular nerve blocks as well as intensity of postoperative analgesia and analgesic consumption. Intensity of intraoperative anaesthesia and duration of postoperative analgesia were significantly higher in the levobupivacaine than in the bupivacaine group. Both anaesthetics showed similar biphasic vasoactive effect.
  
  
  CONCLUSIONS
  Levobupivacaine 0.5 % achieved superiority over bupivacaine 0.5 % in the intensity of intraoperative anaesthesia and duration of postoperative analgesia for lower third molar surgery under the mandibular nerve blocks.
  
  
  CONCLUSIONS
  It seems that the plain levobupivacaine (0.5 %) could be an effective alternative to plain bupivacaine (0.5 %) in those dental procedures which require profound bone and soft tissue anaesthesia.
authors.affiliation: Clinic of Oral Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Denis
authors.initials: D
authors.lastname: Brajkovic
authors.forename: Bozidar
authors.initials: B
authors.lastname: Brkovic
authors.forename: Marija
authors.initials: M
authors.lastname: Milic
authors.forename: Vladimir
authors.initials: V
authors.lastname: Biocanin
authors.forename: Elena
authors.initials: E
authors.lastname: Krsljak
authors.forename: Dragica
authors.initials: D
authors.lastname: Stojic
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000592:standards; D002045:Bupivacaine / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D006801:Humans; D000077554:Levobupivacaine; D008964:Molar, Third / Q000601:surgery*; D010149:Postoperative Pain / Q000517:prevention & control*
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine